title: CT fluoroscopy-guided percutaneous vertebroplasty for the treatment of osteolytic breast cancer metastases: results in 62 sessions with 86 vertebrae treated.
abstract: OBJECTIVE
  This retrospective study aimed to assess the results of computed tomographic (CT) fluoroscopy-guided percutaneous vertebroplasty (PV) of painful osteolytic spinal metastases from breast cancer, focusing on the frequency and clinical impact of polymethylmethacrylate (PMMA) leaks.
  
  
  METHODS
  Within 48 months, 53 patients (52 women; mean age of 62 y +/- 13) with painful osteolytic breast cancer metastases underwent vertebroplasty. Eighty-six vertebrae were treated in 62 sessions under CT fluoroscopy guidance (single slice and four- and 16-row CT). In the planning CT scan, osteolytic destruction (ie, none, < or =25%, < or =50%, < or =75%, or < or =100%) was assessed regarding the vertebral cross-sectional area, the cortical border of the spinal canal, and the outer circumference. CT performed after vertebroplasty was used to detect local PMMA leaks (intradiscal, intraspinal, paravertebral, intercostovertebral/posterolateral, and vascular). Patient charts were reviewed with respect to adverse events. Clinical outcome was assessed on a visual analog scale (VAS) 24 hours before, immediately after, and 6 months after PV.
  
  
  RESULTS
  Overall, 37.2%, 12.8%, and 1.2% of vertebrae (N = 86) showed at least a 50% osteolytic involvement of the cross-sectional area, spinal canal, and outer vertebral cortex, respectively. Intradiscal, intraspinal, paravertebral, and intercostovertebral/posterolateral leaks were seen in 31.3%, 26.9%, 26.9%, and 14.9% of vertebrae, respectively. The ratio of basivertebral to segmental venous leaks was 22.4%/23.9%. No major complications (eg, radiculopathy or pulmonary embolism) occurred. VAS scores decreased significantly (P < .05) from 6.4 at 24 hours before PV to 3.4 at a mean follow-up of 9.2 months.
  
  
  CONCLUSIONS
  PV of osteolytic breast cancer metastases can be performed safely under CT fluoroscopic guidance even with substantial involvement of the vertebral cross-sectional area or cortical bone. A high clinical success rate was achieved and cortical and vascular PMMA leaks had no impact.
authors.affiliation: Department of Clinical Radiology, Klinikum der Universität München-Campus Grosshadern, Munich, Germany.
authors.forename: Christoph Gregor
authors.initials: CG
authors.lastname: Trumm
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Jakobs
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Zech
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Helmberger
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Ralf-Thorsten
authors.initials: RT
authors.lastname: Hoffmann
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D013125:Spinal Neoplasms / Q000556:secondary* / Q000628:therapy*; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*